Healthcare Provider Details

I. General information

NPI: 1184072647
Provider Name (Legal Business Name): CHARTWELL CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MAGAZINE ST
NEW ORLEANS LA
70130-4219
US

IV. Provider business mailing address

1225 MAGAZINE ST
NEW ORLEANS LA
70130-4219
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-2478
  • Fax: 504-899-2416
Mailing address:
  • Phone: 504-899-2478
  • Fax: 504-899-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberL-220
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberL-220
License Number StateLA

VIII. Authorized Official

Name: NICOLE T LASSERRE
Title or Position: CLINICAL DIRECTOR
Credential: PH.D., BCBA-D, LBA
Phone: 504-899-2478